Repeated Antimicrobial Therapy in Children: The Problem of its Effectiveness and Safety

A Ten-Year Survey of the Practice of Simultaneous and Successive Combination Therapy

¹ Associate Clinical Professor of Pediatrics, Marquette University Medical School.

1. In a review of publications on antimicrobial therapy many divergent conclusions as to response to the available drugs are being pointed up. There is no consensus of opinion as to the occurrence and significance of (a) microbial sensitivity and resistance to drugs, (b) synergism, indifference or antagonism of drug combinations, (c) allergic or anaphylactic reactions of the human host.

2. The case histories of 872 patients who had received between three and 20 successive courses of antibiotic or chemotherapy at Milwaukee Children's Hospital within a 10 year period (3158 individual hospital admissions all told) were closely scrutinized and tabulated according to age, number of admissions, diagnoses and complications, type of drug administration, therapeutic response and allergic side effects.

3. The overall frequency of administration of the different drugs, which may be termed an antibiotic popularity contest, shows, as expected, penicillin way out in front with 2,892, followed by sulfonamides 909, streptomycin (given mostly in combination with penicillin) 555, followed by the several tetracycline preparations.

4. Lack of favorable clinical response to chemotherapy was hardly ever encountered although in cases with underlying severe systemic pathology like fibrocystic disease of pancreas, leukemia, congenital malformations, and possibly also agammaglobulinemia, etc., drug treatment could not accomplish more than temporary improvement, at times even after numerous exacerbations.

5. Penicillin, in particular, was administered in as many as 15 courses in one patient, in 248 cases four and more times. The clinical response in practically all cases was entered as partially or entirely favorable. Penicillin-streptomycin combination became a favorite routine in patients before specific bacteriological information was available. Sulfonamides and the tetracyclines were chosen mostly in urinary infections, then whenever bacteriological findings indicated preferential medication and finally in all cases refractory to the more popular drugs; most of these belonged to the prognostically grave category of leukemias, fibrocystic disease and malformations.

6. In 72 cases of asthmatic bronchitis and bronchial asthma no untoward effects of repeated drug administration were noted. In 13 cases of allergic dermatitis 11 showed clearing in spite of repeated antibiotic therapy, only two developed erythema multiforme and roseola respectively without any threatening syndromes.

7. In 228 cases with major or minor surgery antimicrobial drugs were ordered more or less as a routine preoperative or postoperative procedure. In this policy all the attending members of our surgical staff in the different surgical specialties participated about equally. The results appear to have been most gratifying from the surgical as well as medical point of view.

8. There was a total of 39 fatalities out of 872 cases under review. None of them had even a remote causal connection with drug administration, except possibly two pneumonias in infants, one meningococcic meningitis and one ulcerative colitis, which cases might be classified as therapeutic failures. The rest of them were cases of hopeless prognosis like leukemia, congenital malformations, fibrocystic disease. In most of these cases repeated drug therapy was obviously instrumental in prolonging life.

9. On the basis of this varied and unselected material of hospitalized children it can be stated that the benefits of all the older and newer antimicrobial agents by far outweigh their shortcomings. We, therefore, consider it unwise to overemphasize the comparatively rare therapeutic failures and we do not hesitate to encourage the liberal use of these drugs, whenever indicated, by the younger generation of physicians who have never experienced the utter helplessness (except for immune body therapy) of the preantibiotic and prechemotherapeutic era.